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FOR OFFICE USE: r X, -----'-------------:------- -------------------- -------------------------- --------------- --------------------____.__-___.._-..____-----.___-_ APPLICATION FOR SANITATION PERMIT Permit No. . --- - ------------------- ------------------- ---------- {Complete in Duplicate) l ------- ------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and inftwfl-ti-e"work herein described. This application is made in compliance with County Ordinance No. 549. •=- -_ JOB ADDRESS AND LOCATION _. -� -- a r. Owners Name--- Phone ---------;------- ---- -------------- Address__-S �-a ------- - ------------- --- ---- - -------------- ---------- --•--- ----------------------- ------ ---------------------------------------------- Contractor's Name ---- ••------- ---•---•------ Phone__��, --�iyv Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trail Curt ❑ Motel ❑ Other ®� Number of living units: ________ Number of bedrooms _...____ Number of baths_-_- Lot size _11y,6. x141-FQ-------------_---_ Water Supply: Public system ❑ Community system ❑ Private X, Depth to Water Tabi&.!!�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Y Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____------------_---) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 19 i Septic ipk.. Distance from nearest well_-13SD___Distance from foundation.. ._5----- .Material._ . ------ ------ Y - - No. of compartments-------- --- i Size.s}� /_ _.Liquid depth---- ----- --------------Ca acit _�.�Q Disposal Id: Distance from nearest well_3-AR-__.Distance from foundation.-/J� --Distance to nearest lot line_ ___.__ . Number of lines----------- --- - Length of each line_..1�_ -- ------- Width of trench----a------------ -------- Type of filter material__/ _G-Depth of filter material__ _t__'111_____Total length--------- ----4----__________._ Seepage Pit: Distance to nearest well____ _____________Distance from foundation--------------------Distance to nearest lot line______.________._ ❑ Number of pits---------------------Lining material-----------..---- ----.Size: Diameter--------------.-------Depth-.----------------------- - Cesspool: Distance from nearest well------- ---------Distance from foundation....................Lining material---------------------- ❑ Size: Diamete'i----------- -------------------------Depth----------- ----------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-----___----------_----------------------___-----Distance from nearest building------------------------------------------ F1 .________.__-------__________ .❑ Distance to nearest lot line-- - Remodeling and/or repairing (describe)---------------------------------------------------------------------------------------------------° -•----- --------------------------- ---- -----•------------•-----------------------------------------•-------------•---------------------------------------------------------------------------------- ----------------------------------------------------------------------•--•-------•----------------------------------------•------------------•------ ----------------------------- -------------------------------------- -- --------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 'f ordinances, a laws, and rules and gulations of the Sa Joaquin Local Health District. Ir (Signed)_.-- (Owper and/or Contractor) By: -------------------- --- --- Title - -- ---- --------- --- -{ -------------- (Plot plan, showing size of lot, location of system in relation f wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ c- `- DATE- - -- ---------------------------------- ------ --------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED. ------------------------------------------------------------------...----------------- DATE------------------------------ Alterations and/or recommendations---- --- ----------------------------- ' ----------------------------- -------------------------------------------- --------------- FINAL INSPECTION d f Date---/- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.-Hoettton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O. i